ppharmПедиатрическая фармакологияPediatric pharmacology1727-57762500-3089Издательство «ПедиатрЪ»10.15690/pf.v23i1.2999ppharm-2751Research ArticleКЛИНИЧЕСКИЙ СЛУЧАЙCASE REPORTМноголикая лихорадка: клинический случайThe Many Faces of Fever: Case Reporthttps://orcid.org/0000-0002-6137-6138ИвановА. А.IvanovA. A.

Иванов Артем Александрович - врач-педиатр, эксперт-аналитик управления по реализации функций НМИЦ по педиатрии.

117513, Москва, ул. Островитянова, д. 1

Artem A. Ivanov – MD.

1, Ostrovityanova Str., Moscow, 119049

trt.iy@yandex.ruhttps://orcid.org/0009-0009-9443-0485ЛашковаЮ. С.LashkovaJ. S.

Лашкова Юлия Сергеевна - к.м.н.

Москва

Julia S. Lashkova - MD, PhD.

Moscow

yupatr@gmail.comКузнецовИ. С.KuznetsovI. S.

Кузнецов Иван Спартакович

Москва

Ivan S. Kuznetsov - MD.

Moscow

vane1995@yandex.ruhttps://orcid.org/0000-0002-7447-0625КуличенкоТ. В.KulichenkoT. V.

Куличенко Татьяна Владимировна - д.м.н., профессор РАН.

Москва

Tatyana V. Kulichenko - MD, PhD, Professor of the RAS.

Moscow

tkulichenko@yandex.ruРоссийский национальный исследовательский медицинский университет им. Н.И. Пирогова (Пироговский Университет)РоссияPirogov Russian National Research Medical UniversityRussian Federation2026060220262311418Copyright © Иванов А.А., Лашкова Ю.С., Кузнецов И.С., Куличенко Т.В., 20262026Иванов А.А., Лашкова Ю.С., Кузнецов И.С., Куличенко Т.В.Ivanov A.A., Lashkova J.S., Kuznetsov I.S., Kulichenko T.V.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.pedpharma.ru/jour/article/view/2751Обоснование

Обоснование. Лихорадка неясного генеза (как вирусная, так и бактериальная) всегда вызывает диагностические сложности у врачей-педиатров, поскольку может сопровождать различные состояния. Обычно при поиске причин лихорадки рассматривают только инфекционные и соматические, забывая, что она может оказаться проявлением нежелательных реакций на лекарственные препараты (ЛП). Наш клинический случай демонстрирует пример лекарственной лихорадки, возникшей на фоне приема тейкопланина.

Описание клинического случая. Мальчик, 13 лет, обследовался в педиатрическом диагностическом отделении ввиду наличия лихорадки, цитопении. В процессе диагностики у него были исключены частые причины лихорадки — вирусные и бактериальные инфекции. Учитывая отсутствие «красных флагов» (выраженная слабость и вялость, отказ от еды, нарушение дыхания, очаговая и менингеальная симптоматика) в состоянии пациента и факт длительной терапии в стационаре, была рассмотрена гипотеза о лекарственно-индуцированной лихорадке на фоне приема тейкопланина, что впоследствии и подтвердилось. После отмены ЛП все симптомы самостоятельно купировались и в дальнейшем не возникали.

Заключение

Заключение. При проведении дифференциальной диагностики между причинами лихорадки необходимо помнить, что она может быть вызвана такими ятрогенными факторами, как прием некоторых ЛП. Полипрагмазия и нерациональное назначение ЛП — факторы риска развития подобных реакций. Соблюдение принципов рациональной фармакотерапии поможет избежать подобных «рукотворных» осложнений лечения у пациентов.

Background

Background. Fever of unknown origin (viral or bacterial) always presents diagnostic challenges for pediatricians, as it can accompany various conditions. Typically, when searching for the causes of fever, only infectious and somatic causes are considered, forgetting that it can be a manifestation of adverse drug reactions of drug products (DP). Our case report demonstrates an example of druginduced fever that occurred during teicoplanin therapy.

Case report

Case report: A 13-year-old boy was examined in the pediatric diagnostics department due to the presence of fever and cytopenia. During the diagnostic process, common causes of fever—viral and bacterial infections—were ruled out. Considering the absence of “red flags” (severe weakness and lethargy, refusal to eat, breathing difficulties, focal and meningeal symptoms) in the patient’s condition, and the fact of prolonged hospital therapy, the hypothesis of a drug-induced fever associated with teicoplanin use was considered and subsequently confirmed. After discontinuation of the drug, all symptoms resolved spontaneously and did not recur.

Conclusion

Conclusion. When conducting a differential diagnosis for the causes of fever, it is crucial to remember that fever can be caused by iatrogenic factors, such as the usage of certain DP. Polypharmacy and irrational prescription of DP are risk factors for the development of such reactions. Adherence to the principles of rational pharmacotherapy can help avoid such “human-made” complications in patient treatment.

детилихорадкаантибактериальная терапиянежелательные реакциитейкопланинклинический случайchildrenfeverantibacterial therapyadverse drug reactionsteicoplanincase reportОтсутствуетNot specifiedReferencesPiller S, Herzog D. The Burden Of Visits For Fever At A Paediatric Emergency Room: A Retrospective Study On Patients Presenting At The Cantons Hospital Of Fribourg, A Peripheral Public Hospital Of Switzerland. Pediatric Health Med Ther. 2019;10:147–152. doi: https://doi.org/10.2147/PHMT.S219759Piller S, Herzog D. The Burden Of Visits For Fever At A Paediatric Emergency Room: A Retrospective Study On Patients Presenting At The Cantons Hospital Of Fribourg, A Peripheral Public Hospital Of Switzerland. Pediatric Health Med Ther. 2019;10:147–152. doi: https://doi.org/10.2147/PHMT.S219759Намазова-Баранова Л.С., Баранов А.А., Булгакова В.А. и др. Лихорадка у детей: руководство для врачей. — 2-е изд., испр. и доп. — М.: ПедиатрЪ; 2022. — 76 с. — (Болезни детского возраста от А до Я; вып. 21).Намазова-Баранова Л.С., Баранов А.А., Булгакова В.А. и др. Лихорадка у детей: руководство для врачей. — 2-е изд., испр. и доп. — М.: ПедиатрЪ; 2022. — 76 с. — (Болезни детского возраста от А до Я; вып. 21).Острая респираторная вирусная инфекция (ОРВИ): клинические рекомендации / Союз педиатров России. — Минздрав России; 2022. — 42 с. Дотупно по: https://cr.minzdrav.gov.ru/previewcr/25_2. Ссылка активна на 26.01.2026.Ostraya respiratornaya virusnaya infektsiya (ORVI): Clinical guidelines. Union of Pediatricians of Russia. Ministry of Health of Russia; 2022. 42 p. (In Russ).] Дотупно по: https://cr.minzdrav.gov.ru/previewcr/25_2. Ссылка активна на 26.01.2026.Trapani S, Fiordelisi A, Stinco M, Resti M. Update on Fever of Unknown Origin in Children: Focus on Etiologies and Clinical Approach. Children (Basel). 2023;11(1):20. doi: https://doi.org/10.3390/children11010020Trapani S, Fiordelisi A, Stinco M, Resti M. Update on Fever of Unknown Origin in Children: Focus on Etiologies and Clinical Approach. Children (Basel). 2023;11(1):20. doi: https://doi.org/10.3390/children11010020Antoon JW, Potisek NM, Lohr JA. Pediatric Fever of Unknown Origin. Pediatr Rev. 2015;36(9):380–391. doi: https://doi.org/10.1542/pir.36-9-380Antoon JW, Potisek NM, Lohr JA. Pediatric Fever of Unknown Origin. Pediatr Rev. 2015;36(9):380–391. doi: https://doi.org/10.1542/pir.36-9-380Nijman RG, Tan CD, Hagedoorn NN, et al. Are children with prolonged fever at a higher risk for serious illness? A prospective observational study. Arch Dis Child. 2023;108(8):632–639. doi: https://doi.org/10.1136/archdischild-2023-325343Nijman RG, Tan CD, Hagedoorn NN, et al. Are children with prolonged fever at a higher risk for serious illness? A prospective observational study. Arch Dis Child. 2023;108(8):632–639. doi: https://doi.org/10.1136/archdischild-2023-325343Reynolds S, Kadambari S, Calton E, Roland D. The child with prolonged fever: when to think zebras. Paediatrics and Child Health. 2025;35(3). doi: https://doi.org/10.1016/j.paed.2024.12.001Reynolds S, Kadambari S, Calton E, Roland D. The child with prolonged fever: when to think zebras. Paediatrics and Child Health. 2025;35(3). doi: https://doi.org/10.1016/j.paed.2024.12.001Elzagallaai AA, Greff M, Rieder MJ. Adverse Drug Reactions in Children: The Double-Edged Sword of Therapeutics. Clin Pharmacol Ther. 2017;101(6):725–735. doi: https://doi.org/10.1002/cpt.677Elzagallaai AA, Greff M, Rieder MJ. Adverse Drug Reactions in Children: The Double-Edged Sword of Therapeutics. Clin Pharmacol Ther. 2017;101(6):725–735. doi: https://doi.org/10.1002/cpt.677Leitzen S, Dubrall D, Toni I, et al. Adverse Drug Reactions in Children: Comparison of Reports Collected in a Pharmacovigilance Project Versus Spontaneously Collected ADR Reports. Paediatr Drugs. 2023;25(2):203–215. doi: https://doi.org/10.1007/s40272-022-00540-zLeitzen S, Dubrall D, Toni I, et al. Adverse Drug Reactions in Children: Comparison of Reports Collected in a Pharmacovigilance Project Versus Spontaneously Collected ADR Reports. Paediatr Drugs. 2023;25(2):203–215. doi: https://doi.org/10.1007/s40272-022-00540-zSmyth RM, Gargon E, Kirkham J, et al. Adverse drug reactions in children — a systematic review. PLoS One. 2012;7(3):e24061 doi: https://doi.org/10.1371/journal.pone.0024061Smyth RM, Gargon E, Kirkham J, et al. Adverse drug reactions in children — a systematic review. PLoS One. 2012;7(3):e24061 doi: https://doi.org/10.1371/journal.pone.0024061Ochi H, Wada K, Okada H, et al. The persistence of drug-induced fever by teicoplanin — a case report. Int J Clin Pharmacol Ther. 2011;49(5):339–343. doi: https://doi.org/10.5414/cp201430Ochi H, Wada K, Okada H, et al. The persistence of drug-induced fever by teicoplanin — a case report. Int J Clin Pharmacol Ther. 2011;49(5):339–343. doi: https://doi.org/10.5414/cp201430Perrett CM, McBride SR. Teicoplanin induced drug hypersensitivity syndrome. BMJ. 2004;328(7451):1292. doi: https://doi.org/10.1136/bmj.328.7451.1292Perrett CM, McBride SR. Teicoplanin induced drug hypersensitivity syndrome. BMJ. 2004;328(7451):1292. doi: https://doi.org/10.1136/bmj.328.7451.1292Kim BK, Kim JH, Sohn KH, et al. Incidence of teicoplanin adverse drug reactions among patients with vancomycinassociated adverse drug reactions and its risk factors. Korean J Intern Med. 2020;35(3):714–722. doi: https://doi.org/10.3904/kjim.2018.404Kim BK, Kim JH, Sohn KH, et al. Incidence of teicoplanin adverse drug reactions among patients with vancomycinassociated adverse drug reactions and its risk factors. Korean J Intern Med. 2020;35(3):714–722. doi: https://doi.org/10.3904/kjim.2018.404Labbus K, Junkmann JK, Perka C, et al. Antibiotic-induced fever in orthopaedic patients-a diagnostic challenge. Int Orthop. 2018;42(8):1775–1781. doi: https://doi.org/10.1007/s00264-018-3909-8Labbus K, Junkmann JK, Perka C, et al. Antibiotic-induced fever in orthopaedic patients-a diagnostic challenge. Int Orthop. 2018;42(8):1775–1781. doi: https://doi.org/10.1007/s00264-018-3909-8Someko H, Kataoka Y, Obara T. Drug fever: a narrative review. Ann Clin Epidemiol. 2023;5(4):95–106. doi: https://doi.org/10.37737/ace.23013Someko H, Kataoka Y, Obara T. Drug fever: a narrative review. Ann Clin Epidemiol. 2023;5(4):95–106. doi: https://doi.org/10.37737/ace.23013Han J, Ye YM, Lee S. Epidemiology of drug hypersensitivity reactions using 6-year national health insurance claim data from Korea. Int J Clin Pharm. 2018;40(5):1359–1371. doi: https://doi.org/10.1007/s11096-018-0625-9Han J, Ye YM, Lee S. Epidemiology of drug hypersensitivity reactions using 6-year national health insurance claim data from Korea. Int J Clin Pharm. 2018;40(5):1359–1371. doi: https://doi.org/10.1007/s11096-018-0625-9Bigi C, Tuccori M, Bocci G. Healthcare professionals and pharmacovigilance of pediatric adverse drug reactions: a 5-year analysis of Adverse Events Reporting System Database of the Food and Drug Administration. Minerva Pediatr (Torino). 2022;74(3):272–280. doi: https://doi.org/10.23736/S2724-5276.17.04733-8Bigi C, Tuccori M, Bocci G. Healthcare professionals and pharmacovigilance of pediatric adverse drug reactions: a 5-year analysis of Adverse Events Reporting System Database of the Food and Drug Administration. Minerva Pediatr (Torino). 2022;74(3):272–280. doi: https://doi.org/10.23736/S2724-5276.17.04733-8Uwai Y, Nabekura T. Analysis of adverse drug events in patients with bipolar disorders using the Japanese Adverse Drug Event Report database. Pharmazie. 2022;77(7):255–261. doi: https://doi.org/10.1691/ph.2022.2386Uwai Y, Nabekura T. Analysis of adverse drug events in patients with bipolar disorders using the Japanese Adverse Drug Event Report database. Pharmazie. 2022;77(7):255–261. doi: https://doi.org/10.1691/ph.2022.2386Lorrot M, Gillet Y, Gras Le Guen C, et al. Antibiotic therapy of bone and joint infections in children: proposals of the French Pediatric Infectious Disease Group. Arch Pediatr. 2017;24(12S):S36–S41. doi: https://doi.org/10.1016/S0929-693X(17)30517-1Lorrot M, Gillet Y, Gras Le Guen C, et al. Antibiotic therapy of bone and joint infections in children: proposals of the French Pediatric Infectious Disease Group. Arch Pediatr. 2017;24(12S):S36–S41. doi: https://doi.org/10.1016/S0929-693X(17)30517-1Gornitzky AL, Kim AE, O’Donnell JM, Swarup I. Diagnosis and Management of Osteomyelitis in Children: A Critical Analysis Review. JBJS Rev. 2020;8(6):e1900202. doi: https://doi.org/10.2106/jBJS.RVW.19.00202Gornitzky AL, Kim AE, O’Donnell JM, Swarup I. Diagnosis and Management of Osteomyelitis in Children: A Critical Analysis Review. JBJS Rev. 2020;8(6):e1900202. doi: https://doi.org/10.2106/jBJS.RVW.19.00202Gallagher RM, Bird KA, Mason JR, et al. Adverse drug reactions causing admission to a paediatric hospital: a pilot study. J Clin Pharm Ther. 2011;36(2):194–199. doi: https://doi.org/10.1111/j.13652710.2010.01194.x.Gallagher RM, Bird KA, Mason JR, et al. Adverse drug reactions causing admission to a paediatric hospital: a pilot study. J Clin Pharm Ther. 2011;36(2):194–199. doi: https://doi.org/10.1111/j.13652710.2010.01194.x.Haffner S, von Laue N, Wirth S, Thürmann PA. Detecting adverse drug reactions on paediatric wards: intensified surveillance versus computerised screening of laboratory values. Drug Saf. 2005;28(5):453–464. doi: https://doi.org/10.2165/00002018-200528050-00008Haffner S, von Laue N, Wirth S, Thürmann PA. Detecting adverse drug reactions on paediatric wards: intensified surveillance versus computerised screening of laboratory values. Drug Saf. 2005;28(5):453–464. doi: https://doi.org/10.2165/00002018-200528050-00008Rashed AN, Wong IC, Cranswick N, et al. Adverse Drug Reactions in Children--International Surveillance and Evaluation (ADVISE): a multicentre cohort study. Drug Saf. 2012;35(6):481–494. doi: https://doi.org/10.2165/11597920-000000000-00000Rashed AN, Wong IC, Cranswick N, et al. Adverse Drug Reactions in Children--International Surveillance and Evaluation (ADVISE): a multicentre cohort study. Drug Saf. 2012;35(6):481–494. doi: https://doi.org/10.2165/11597920-000000000-00000Velasco R, Gomez B, Labiano I, et al. Performance of Febrile Infant Algorithms by Duration of Fever. Pediatrics. 2024;153(5):e2023064342. doi: https://doi.org/10.1542/peds.2023-064342Velasco R, Gomez B, Labiano I, et al. Performance of Febrile Infant Algorithms by Duration of Fever. Pediatrics. 2024;153(5):e2023064342. doi: https://doi.org/10.1542/peds.2023-064342Hamilton JL, Evans SG, Bakshi M. Management of Fever in Infants and Young Children. Am Fam Physician. 2020;101(12):721– 729.Hamilton JL, Evans SG, Bakshi M. Management of Fever in Infants and Young Children. Am Fam Physician. 2020;101(12):721– 729.

The authors declare that there are no conflicts of interest present.